ratio of 1.3:1. Out of 95, 82 (86%) were B cell, 7 (7.4%) Tcell, 4 (4.2%) Infant and 2 (2.1%) mixed phenotype ALL. High count disease (>40,000/mm3 initial WBC count) in 16 (16.8%). High risk cytogenetics positivity BCR ABL- 4 (4.2%) & MLL-8 (8.4%). Intermediate risk cytogenetics E2A positive-6 (6.5%). Good risk Tel AML positive- 21 (23%). Hyperdiploidy-15(15.8%), Hypodiploidy-6(6.3%). Day 33 MRD positive-16 (16.8%). Day 78 MRD done in those with Day 33 positive, was negative for all 16. In terms of outcome, 5 (5.3%) relapsed off treatment out of which 3 expired and 2 are on treatment. 4 expired during intensive treatment due to febrile neu- tropenia. Out of the 5 relapse cases, 4 had positive MRD on Day 33, showing a positive correlation between Day 33 MRD and relapse rate. No statistically significant correlation could be demonstrated between high risk cytogenetics/ WBC count/ type of ALL/ karyotype and Day 33 MRD in our study. Conclusion: This study points out that doing MRD on Day 33 in all cases of ALL is useful to predict the risk of relapse, though confirmation requires further follow-up. As this is just an interim analysis, we propose to carry out further study and data collection to confirm our results AUTOIMMUNE DISORDERS IN HODGKIN LYMPHOMA: A SINGLE CENTRE EXPERIENCE Nitu Kumari, Priyanka Aggarwal, Vineeta Gupta. Division of Hematology Oncology, Department of Pediatrics, Institute of medical Sciences, Banaras Hindu University, Varanasi Introduction: Several autoimmune disorders have been observed in as- sociation with Hodgkin lymphoma (HL) including autoimmune hemolytic anemia (AIHA), immune thrombocytopenia and nephrotic syndrome. AIHA is characterized by production of autoantibodies against erythrocyte, leading to hemolysis. It is uncommon in the pediatric population. Nephrotic syndrome is a rare part of the paraneoplastic syndrome. Mini- mal change nephropathy is the most frequently observed renal manifestation. Methods: Retrospective data analysis was carried out from year 2004 to 2019 for patients with Hodgkin Lymphoma presenting with autoimmune disorders. All patients had detailed history, physical examination and in- vestigations to confirm the diagnosis. They received treatment as per unit protocol with chemotherapy (ABVD) with/without radiotherapy. Results: 119 patients in the age group of 3.5 e 16 years were diagnosed with Hodgkin lymphoma. Mean age was 7.6 years. 81.8 % had B symptoms. Early disease was seen in only 11.1% patients while rest had advanced disease (stages 2 B, 3 and 4). In the present series, there were only two patients (1.7%) who had associated autoimmune disorders. Case 1: 11 year male presented with fever, progressive paleness and jaundice. Examination showed pallor, icterus, significant cervical lymph- adenopathy and hepatosplenomegaly. Hb was very low (2.3 g/dl), LFT revealed elevated TB/DB (2.5/1.1). GBP and BMA were suggestive of he- molytic picture. DCT was positive with high reticulocyte count. Lymph node biopsy was suggestive of Hodgkin lymphoma. His was staged as IIIB. He was treated with oral steroids for two weeks with ABVD protocol and made complete recovery. Case 2: 7 year female presented with anasarca and cervical lymphade- nopathy. She had nephrotic range proteinuria, hypoalbuninemia and renal parenchymal disease on USG. Cervical node biopsy confirmed Hodgkin lymphoma. Her staging was IIB. She received chemotherapy and achieved complete remission. Conclusion: Both nephrotic syndrome and AIHA are well recognized but rare entities in children with Hodgkin lymphoma. Possible mechanism is antibody formation against tumour cells which also destroys the red blood cells. Corticosteroids are the mainstay of therapy. Prolonged proteinuria may be a paraneoplastic syndrome. Effective treatment of Hodgkin lym- phoma generally results in remission of nephrotic syndrome. CHARACTERIZATION OF BONE MARROW INVOLVEMENT IN PEDIATRIC HODGKIN LYMPHOMA USING 18 F-FDG-PET/CT AND ITS COMPARISON WITH BLIND BONE MARROW BIOPSY Shuvadeep Ganguly, Rachna Seth, Rakesh Kumar, Mehar C. Sharma, Jagdish P. Meena, Aditya K. Gupta. Pediatric Oncology Division, All India Institute of Medical Sciences, New Delhi Abstract Background: Bone marrow involvement in Hodgkin lymphoma upstages the disease and is associated with poor prognosis. Bone marrow biopsy of bilateral iliac crestis an invasive procedure which is likely to miss focal bone marrow involvement elsewhere. The role of whole body FDG-PET/CT in baseline staging for detection of bone marrow involvement in pediatric Hodgkin lymhoma was explored in this study. Methods: Pathologically confirmed cases of pediatric Hodgkin lymphoma (16years) were prospectively recruited. All patients underwent a whole body FDG-PET/CT scan along with blind bone marrow biopsy from bilateral iliac crest. FDG-PET/CT scans were interpreted by 2 nuclear medicine physicians and bone marrow biopsies were interpreted by a pathologist who were blinded to findings of second modality. Semiquantitative anal- ysis of FDG-PET/CT were also explored. The difference of median between 2 groups were calculated using Mann Whitney U test and p value <0.05 was considered significant. Results: Of the 37 patients who underwent both bone marrow biopsy and FDG-PET/CT scan,bone marrow biopsy were positive in 6 patients (16.2%). True positive bone marrow involvement was seen in 14 (37.9%) patients while 6 patients (26.2%) showed false positive marrow uptake. The sensitivity, specificity, PPV, NPV of FDG-PET/CT in identifying bone marrow involvement scan were 100%, 73.9%, 70%, 100% respectively.Se- miquantitative analysis showed the median values of SUVmax marrow/ liver ratio [3.409;IQR 2.149-6.87 vs 1.339; IQR1.041-2.162; p ¼0.0003] and SUVmax marrow/mediastinal blood pool structure ratio [8.097; IQR 3.273-9.489 vs 1.35;IQR 1.041-3.04; p¼0.0001] were significantly higher in those with actual bone marrow involvement. Area under ROC curve SUVmax marrow/liver ratio and SUVmax marrow/mediastinal blood pool structure ratio were 0.846 (95%CI: 0.718-0.974) and 0.863 (95%CI: 0.741-0.986) respectively suggesting good discrimination value of these parameters. Conclusion: FDG-PET/CT is a highly sensitive test to detect bone marrow involvement at baseline in pediatric Hodgkin lymphoma which is espe- cially important as the marrow involvement is often focal. High negative predictive value suggests in presence of negative involvement in FDG PET/ CT, bone marrow biopsy may be omitted at baseline. Semiquantitative analysis of PET/CT scan can also be added on to visual interpretation for detecting true bone marrow involvement. CHRONIC EOSINOPHILIC LEUKAEMIA NOS TRANSFORMING TO B LYMPHOBLASTIC LEUKAEMIA PRESENTING AS MYOCARDIAL INFARCTION IN A CHILD Prasanth Varikkattu Rajendran, Priya kumari Thankamony, Manjusha Nair, Guruprasad Chellappan Sojamani, Jayasudha Arundhathi Vasudevan, Arun Gopalakrishnan. Paediatric Oncology, Pathology, Cardiology, Regional Cancer Centre, Kerela Background: Chronic eosinophilic leukemia-not otherwise specified (CEL- NOS) is a rare disorder with hypereosinophilia and an increase number of blood or marrow blasts (<20%) or an evidence of eosinophilic clonality with manifestation of organ involvement related to eosinophil infiltration. Case Report: A 11-year-old boy presented with fatigue, vomiting and headache of 1-week duration. There was no other neurological, pulmonary or cardiac symptom or sign. On admission, physical examination was negative except for bilateral axillary lymph nodes . Laboratory findings showed hyperleukocytosis (WBC 3,35,000/mL) with marked hyper- eosinophilia (83%), normal hemoglobin (Hb 11.8g/dL) and thrombocyto- penia (36,000/mL) . Peripheral smear examination showed severe eosinophilia and no abnormal cells. Bone marrow examination showed cellular marrow with myeloid hyperplasia, severe eosinophilia and mul- tiple clusters of immature cells with blasts around 8%. Blasts were Tdt positive, CD34 positive, CD20 negative, PAX5 positive, CD10 positive, CD3 negative, CD5 negative, CD7 negative and myeloperoxidase negative with no karyotypic abnormalities. Mutations for Chronic eosinophilic syndrome like FIP1L1/PDGFRA fusion genes, JAK 2 exon 14 mutation , FGFR1 rear- rangement ,ETV6-PDGFRB fusion gene, turned negative . BCR-ABL was also negative. Taking morphology, immunophenotype and cytogenetics results into consideration a diagnosis of Chronic eosinophilic leukaemia NOS with B Lymphoblastic Leukaemia transformation was made. Following admis- sion child developed decompensated heart failure with ST segment Abstracts / Pediatric Hematology Oncology Journal 4 (2019) S24eS31 S30